Cognitive Pearl #035 Tevet 29, 5775 January 20, 15

In yesterday’s post, I introduced the first phase of the cognitive treatment of OCD: The identification and demarcation of OCD symptoms. With the client’s awareness of what are ‘symptoms’, ‘triggers’, ‘secondary symptoms’, as well as his emotional states, we move onto neutralizing the OCD.

There are two other areas that should be considered in the data collection phase. The first relates to the client’s pre-morbid personality and temperament. At this stage there is no need to conduct an exhaustive evaluation. What you’re looking to determine is whether he is, using a common expression, a control freak. How does he respond to the unknown or to the unexpected? What are his fears and ambitions? Is his life filled with enjoyment which his OCD is getting in the way of? Or is the OCD some sort of compensatory mechanism?

It’s also important to consider his environment. How have his family, friends, and coworkers adjusted to his OCD? Are they aware of it? Is the OCD somehow connected to them? Will they needed to be in enlisted in his treatment? All of these factors can ‘make or break’ the success of his treatment.

As we approach the second phase of the cognitive treatment, it is important to state up front that all cognitive therapy interventions have a common goal: to place distance in between the thinker and the thought. OCD, like depression, and anxiety, and psychosis, wreak their havoc by being so in our face that we don’t have an opportunity to check them for accuracy. These experiences become embodied, so real that they feel as though they define us and all of our totality. It’s a hijacking from the inside. Cognitive therapy aims to find the gap in between.